Inhaled corticosteroids and risk of lower respiratory tract infection with<i>Moraxella catarrhalis</i>in patients with chronic obstructive pulmonary disease

Johnsen, Rikke Helin; Heerfordt, Christian Kjer; Boel, Jonas Bredtoft; Dessau, Ram Benny; Ostergaard, Christian; Sivapalan, Pradeesh; Eklöf, Josefin; Jensen, Jens-Ulrik Stæhr

doi:10.1136/bmjresp-2023-001726

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…I flere nyere og større observationsstudier har man påvist en klar sammenhaeng mellem brugen af ICS og risikoen for isolation af såvel H. influenza, M. catarrhalis, S. pneumonia som P. aeruginosa hos patienter med KOL [18][19][20][21]. Derudover er der studier, der har rapporteret, at ICS også er en betydelig risikofaktor for infektion med nontuberkuløse mykobakterier ved KOL [22].…”

Section: Ugeskrift For Laeger Ugeskrift For Laegerunclassified

Complicated bacterial lung infections in patients with COPD

Eklöf,

Sivapalan,

Jensen

2024

Ugeskr Læger

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Patients with COPD are at increased risk of lung infections. Specific pathogens, including Pseudomonas aeruginosa, are associated with severe exacerbations requiring hospitalisation and death. New research summarised in this review highlights the importance of inhaled corticosteroids as a risk factor for lung infections. Reduction and discontinuation of treatment should be considered in patients with frequent or persistent infections. Long-term treatment with azithromycin and inhaled antibiotics may effectively reduce severe exacerbations in COPD.

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Section: Ugeskrift For Laeger Ugeskrift For Laegerunclassified

Complicated bacterial lung infections in patients with COPD

Eklöf,

Sivapalan,

Jensen

2024

Ugeskr Læger

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“…Cardiac events are significant complications for LRTI patients, and comorbid chronic heart disease may predispose OSA patients to these events [ 115 ]. Similarly, comorbid COPD is important as these patients often receive corticosteroids, increasing pneumonia risk [ 116 ]. Many studies confirmed OSA as an independent risk factor, often adjusted for chronic diseases as covariates.…”

Section: Obstructive Sleep Apnea and Lower Respiratory Tract Infectio...mentioning

confidence: 99%

Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review

Nemet,

Vukoja

2024

Antibiotics

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Both obstructive sleep apnea (OSA) and acute lower respiratory tract infections (LRTIs) are important global health issues. The pathophysiological links between OSA and LRTIs include altered immune responses due to chronic intermittent hypoxia and sleep fragmentation, increased aspiration risk, and a high burden of comorbidities. In this narrative review, we evaluated the current evidence on the association between OSA and the incidence and outcomes of acute LRTIs in adults, specifically community-acquired pneumonia and viral pneumonia caused by influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies have demonstrated that OSA patients are more likely to develop bacterial pneumonia and exhibit a higher risk of invasive pneumococcal disease. The risk intensifies with the severity of OSA, influencing hospitalization rates and the need for intensive care. OSA is also associated with an increased risk of contracting influenza and suffering more severe disease, potentially necessitating hospitalization. Similarly, OSA contributes to increased COVID-19 disease severity, reflected by higher rates of hospitalization, longer hospital stays, and a higher incidence of acute respiratory failure. The effect of OSA on mortality rates from these infections is, however, somewhat ambiguous. Finally, we explored antibiotic therapy for OSA patients with LRTIs, addressing care settings, empirical regimens, risks, and pharmacokinetic considerations. Given the substantial burden of OSA and its significant interplay with acute LRTIs, enhanced screening, targeted vaccinations, and optimized management strategies for OSA patients should be prioritized.

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“…Long-term use of ICS itself might contribute to potentially deleterious airway microbiota changes by increasing the bacterial load of potentially pathogenic germs. ICS use in COPD subjects has been associated with dose-dependent increased risks of acquiring Haemophilus influenzae [57], Streptococcus pneumoniae [58], Moraxella catarrhalis [59], and Pseudomonas aeruginosa colonization [60]. Leitao et al evaluated the effects of a 12-week treatment with ICS/LABA combination vs. LABA alone on the airway microbiome of stable COPD subjects via bronchoalveolar lavage.…”

Section: Mouth and Upper Airways Disturbances Pneumonia Other Lung In...mentioning

confidence: 99%

Inhaled Corticosteroids in Subjects with Chronic Obstructive Pulmonary Disease: An Old, Unfinished History

Melani,

Croce,

Fabbri

et al. 2024

Biomolecules

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Chronic obstructive pulmonary disease (COPD) is one of the major causes of disability and death. Maintenance use of inhaled bronchodilator(s) is the cornerstone of COPD pharmacological therapy, but inhaled corticosteroids (ICSs) are also commonly used. This narrative paper reviews the role of ICSs as maintenance treatment in combination with bronchodilators, usually in a single inhaler, in stable COPD subjects. The guidelines strongly recommend the addition of an ICS in COPD subjects with a history of concomitant asthma or as a step-up on the top of dual bronchodilators in the presence of hospitalization for exacerbation or at least two moderate exacerbations per year plus high blood eosinophil counts (≥300/mcl). This indication would only involve some COPD subjects. In contrast, in real life, triple inhaled therapy is largely used in COPD, independently of symptoms and in the presence of exacerbations. We will discuss the results of recent randomized controlled trials that found reduced all-cause mortality with triple inhaled therapy compared with dual inhaled long-acting bronchodilator therapy. ICS use is frequently associated with common local adverse events, such as dysphonia, oral candidiasis, and increased risk of pneumonia. Other side effects, such as systemic toxicity and unfavorable changes in the lung microbiome, are suspected mainly at higher doses of ICS in elderly COPD subjects with comorbidities, even if not fully demonstrated. We conclude that, contrary to real life, the use of ICS should be carefully evaluated in stable COPD patients.

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Inhaled corticosteroids and risk of lower respiratory tract infection withMoraxella catarrhalisin patients with chronic obstructive pulmonary disease

Cited by 4 publications

References 26 publications

Complicated bacterial lung infections in patients with COPD

Complicated bacterial lung infections in patients with COPD

Obstructive Sleep Apnea and Acute Lower Respiratory Tract Infections: A Narrative Literature Review

Inhaled Corticosteroids in Subjects with Chronic Obstructive Pulmonary Disease: An Old, Unfinished History

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